TREATMENT FOR SYPHILIS

Treatment of syphilis starts with prevention. Prevention measures include seeking regular medical care throughout a lifetime. Regular medical care allows a health care professional to best evaluate a person's individual risks of catching syphilis and regularly test for the disease. These measures greatly increase the chances of catching and curing syphilis in its earliest stage before serious complications occur.

Other preventive measures include abstaining from sexual activity or having sex only within a mutually monogamous relationship in which neither partner is infected with syphilis or another sexually transmitted disease. Latex condoms also provide some protection when used properly.

Primary Syphilis: (the first stage of syphilis) is a single intramuscular injection of the antibiotic penicillin. More doses of penicillin may be required for people who have had syphilis for more than a year.

Secondary syphilis: Administration of penicillin I.M. is the treatment of choice. For early syphilis, treatment may consist of a single injection of penicillin G benzathine I.M. (2.4 million units). Syphilis of more than 1 year’s duration should be treated with penicillin G benzathine I.M. (2.4 million units/week for 3 weeks).

Non pregnant patients who are allergic to penicillin may be treated with oral tetracycline or doxycycline for 15 days for early syphilis and for 30 days for late infections. Non penicillin therapy for latent or late syphilis should be used only after neurosyphilis has been excluded. Tetracycline is contraindicated in pregnant women. Patients who receive treatment must abstain from sexual contact until the syphilis sores are completely healed.

Tertiary Syphilis: Parenteral penicillin G. Late syphilis (Tertiary syphilis, neurosyphilis, syphilis >1yr or unknown duration)

Asymptomatic
Benzathine penicillin IM weekly for 3 doses, or procaine penicillin daily for 15 days
Repetition of blood tests - to ensure treatment successful.

Symptomatic
IV Crystalline penicillin for 10-14 days or IM procaine penicillin plus probenecid daily.

If syphilis affects the eyes, inner ears, or brain, penicillin may be given intravenously every 4 hours for 10 to 14 days. People who are allergic to penicillin may be given other antibiotics such as ceftriaxone,
(given by injection daily for 10 days) or doxycycline.
(taken by mouth for 14 days).

NB: Because people with primary or secondary syphilis can pass the infection to others, they must avoid sexual contact until they and their sex partners have completed treatment. If people have primary-stage syphilis, all their sex partners of the previous 3 months are at risk of being infected. If they have secondary-stage syphilis, all sex partners of the previous year are at risk. Such sex partners require a blood test for antibodies to the bacteria. If test results are positive, the sex partners need to be treated. Some doctors simply treat all sex partners without waiting for test results.

More than half of people with syphilis in an early stage, especially those with secondary-stage syphilis, develop a reaction 2 to 12 hours after the first treatment. This reaction, called a Jarisch-Herxheimer reaction, causes fever, headache, sweating, shaking chills, and a temporary worsening of the sores caused by syphilis. Doctors sometimes mistake this reaction for an allergic reaction to penicillin. Rarely, people with neurosyphilis have seizures or become paralyzed. Symptoms of this reaction usually subside within 24 hours and rarely cause permanent damage.

After treatment, examinations and blood tests are done periodically until no infection is detected. If treatment of primary, secondary, or latent-stage syphilis is successful, most people have no more symptoms. But treatment of tertiary-stage syphilis cannot reverse any damage done to organs, such as the brain or heart. People with such damage usually do not improve after treatment. People who have been cured of syphilis do not become immune to it and can be infected again.

It is also important to abstain from sexual activity until all chancre sores are healed and a licensed health care provider has determined that the infection is cured. It is also important to notify and treat all sexual partners of the syphilis infection, even if they have no symptoms.